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42-079-002 (5) BP-2023-1143 114 GLENDALE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 42-079-002 CITY OF NORTHAMPTON Permit: Agricultural All Bldgs PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1143 PERMISSION IS HEREBY GRANTED TO: Project# NEW SHELTER 2023 Contractor: License: PYRAMID NETWORK SERVICES Est. Cost: 140000 LLC Const.Class: Exp.Date: Use Group: Owner: AMERICAN TOWER CORPORATION Lot Size (sq.ft.) Zoning: SC Applicant: PYRAMID NETWORK SERVICES LLC Applicant Address Phone: Insurance: 6615 TOWPATH RD 315-701-1300 EWC-053-03-75-02 EAST SYRACUSE, NY 13057 ISSUED ON: 08/28/2023 TO PERFORM THE FOLLOWING WORK: 12X18 SHELTER WITH DIESEL GENERATOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: rft t Air-- „2. Fees Paid: $ 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner File #BP-2023-1143 Qt` APPLICANT/CONTACT PERSON:PYRAMID NETWORK SERVICES LLC 6615 TOWPATH RD EAST SYRACUSE, NY 13057 315-701-1300 PROPERTY LOCATION 114 GLENDALE RD MAP:LOT 42-079-002 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $ Type of Construction: 12X18 SHELTER WITH DIESEL GENERATOR New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: A W I I-H I m rxiST113, uce ))4 AMA XApproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR _Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 4,9'I517410 Sign ture of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission, Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. f*c The Commonwealth of Ma ac us a gy Office of Public Safety and In-.ecti ns 2 320,23 Massachusetts State Building Cod' 780� �•! Building Permit Application for any Building other than a $ 4°f dr . .mily Dw: ling (This Section For Official Use Only) Atifi TON444 ,NSpFCr urn drys Building Permit Number:;?3" i 1 13 Date Applied: Building Official: SECTION 1:LOCATION 114 Glendale Rd., Northampton, MA 01062 American Tower Monopole No.and Street City/Town Zip Code Name of Building(if applicable) 42-079-002 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used 9 If New Construction check here 0 or check all that apply in the two rows below Existing Building❑ Repair 0 Alteration 0 Addition ISI Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ICJ Specify:Adding new shelter&antennas to existing cell tower compound. Are building plans and/or construction documents being supplied as part of this permit application? Yes El No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No IXI Brief Description of Proposed Work: Adding a new 12'x18' shelter with diesel generator enclosure to an existing tower compound owned by American Tower. Includes adding new antennas and coax to the existing tower and connecting to new shelter. Also includes removing some existing items in the compound to make room for the new shelter. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 1 134 Total Area(sq.ft.)and Total Height(ft.) 216 9 SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 0 I-4 0 M: Mercantile 0 t: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility® Special Use 0 and please describe below: Special Use Description: Communications Tower SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IBCI IIA ❑ IIB 0 IIIAO IIIBO IV CI VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: A trench will not be Licensed Disposal Site Public 0 N/A Check if outside Flood Zone El Indicate municipal 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 N/A permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable El Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No IX) Yes® No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 9 Use Group(s): U Type of Construction: VB Does the building contain an Sprinkler System?: No Special Stipulations: N/A Design Occupant Load per Floor and Assembly space: N/A SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner American Tower Corporatiok 3500 Regency Parkway, Ste 100 Cary, NC 27518 Name(Print) No.and Street City/Town Zip Property Ow‘ier Contact Information: Austin Sniezek, Acct PM' 781 _926 _ 4760 _ Austin.sniezek@americantower.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Mike DiMonda(Pyramid Network Services) 6615 Towpath Road East Syracuse NY 13057 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals) William R. Heiden, III 574- 527 - 3717 wheiden@m1comm.com 45044 Name(Registrant) Telephone No. e-mail address Registration Number 6202 Constitution Dr,Suite C Fort Wayne IN 46804 Engineer 6/30/2024 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Pyramid Network Services, LLC Company Name Mike DiMonda Name of Person Responsible for Construction License No. and Type if Applicable 6615 Towpath Road _ East Syracuse NY 13057 Street Address City/Town State Zip 518 _ 366 - 5679 mdimonda@pyramidns.com Telephone No.(business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes® No Cl SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 140,000.00 1.Building $ 140,000.00 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northampton 6.Total Cost •$ 140,000.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Mike DiMonda Project Manager 518 -366 - 5679 8/23/23 Please print and sign name Title Telephone No. Date 6615 Towpath Road East Syracuse NY 13057 mdimonda@pyramidns.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: . ,• � � �3 Name Date c_ l ne commonweacan of ivlassuenuseus Department of Industrial Accidents ;r)r6 Office of Investigations Lafayette City Center 4{{4 _`� 2 Avenue de Lafayette, Boston, MA 02111-1750 �� /'ta': www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pyramid Network Services LLC Address:6615 Towpath Road City/State/Zip:East Syracuse, NY 13057 Phone #:315-701-1300 Are you an employer? Check the appropriate box: Type of project (required): 1.❑ I am a employer with 4. ■❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p �' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no Communications Tower Upgrades employees. [No workers' 13.❑■ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:The Cincinnati Casualty Company Policy#or Self-ins. Lic. #:EWC 053 03 75-02 Expiration Date:04-01-2024 Job Site Address: 114 Glendale Road City/State/Zip: Florence, MA 01062 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde ,the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 08/22/2023 Phone#: 315-701-1300 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (check one): 11=1Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.❑Other Contact Person: Phone#: DATE(MM/DD/YYYY) A CCM 0® CERTIFICATE OF LIABILITY INSURANCE 4/26/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Naylor, Freyer&Coon, Inc. PHONE Ashley Franczak FAX PO Box 4743 AA/C,No,Ext): 315-451-1500 (A/C,No): Syracuse NY 13221 ADDRESS: certificates@haylor.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Cincinnati Insurance Co 10677 INSURED WIDEWATERS1 INSURER B: Cincinnati Casualty Company 28665 Pyramid Network Services LLC 6615 Towpath Road INSURER C:Affiliated FM Insurance Company 10014 East Syracuse, NY 13057 INSURERD:Allianz Global Risks US Insurance Co 35300 INSURER E: Indian Harbor Insurance 36940 INSURER F: COVERAGES CERTIFICATE NUMBER:1324214315 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSD SUBR POLICY EFF POLICY EXP WVD POLICY NUMBER LIMITS (MM/DD/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y EPP0573971 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 X Contractual Liab MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y EBA0569119 4/1/2023 4/1/2024 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ A )( UMBRELLA LIAB X OCCUR Y Y EPP0571018 4/1/2023 4/1/2024 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION Y EWC0530375 4/1/2023 4/1/2024 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Leased/Rented Equipment 1097527 4/1/2023 4/1/2024 $250,000 Limit Ded$10,000 D Builders Risk SML93079360 4/1/2023 4/1/2024 $1,000,000 Limit Ded$10,000 E Professional Liability MPP003900609 4/1/2023 4/1/2024 $2,000,000 Claim/Agg $50,000 Ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) General Liability Blanket Additional Insured-Owners/Contractors-Automatic status when required by written contract per Form GA472 09/18 General Liability Blanket Additional Insured on a Primary and Noncontributory basis and Waiver of Subrogation applies in favor of Certificate Holder when required by written contract per Form GA233NY 10/20 Auto Liability Blanket Additional Insured and Waiver of Subrogation as required by written contract Form AA288 01/16 Workers Compensation Waiver of Subrogation Form WC 00 03/13 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton 212 Mains St Northampton MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Initial Construction Control Document i To be submitted with the building permit application by a l Registered Design Professional Tc for work per the 8th edition of the r\,,,..... , See~ Massachusetts State Building Code, 780 CMR, Section 107.6.2 me Project Title: Glendale Rd/Northampton Landfill Date: 8/17/23 Property Address: 114 Glendale Rd., Florence, MA 01062 Project: Check(x)one or both as applicable:❑✓ New construction El Existing Construction Project description: Installation of telecommunication antennas,assoc. mounts, &equip. I William R. Heiden, III MA Registration Number: 45044 Expiration date: 6/30/24 ,am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Entire Project _ Architectural '� Structural Mechanical Fire Protection Electrical ✓ Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. .0HaF4ldq Enter in the space to the right a"wet"or . d.o electronic signature and seal: o WILLIAM R. "Pe.._ HEIDEN,ID in CIVIL - 0 No.4504t ti (800) 377-2929 '1'A $' 'tr ,0A-10Aip" 1'' •4 Email: wheiden@mlcomm.com Phone number: i,_ f °"�<, w ice irrwr,+ Building Official Use Only 8/17/23 Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Trial Version 10 09 2012 COMMONWEALTH OF MASSACHUSETTS 7r. CONSTRUCTION CONTROL AFFIDAVIT 4z _ 8tn Edition of the Massachusetts State Building Code,780 CMR,Section 107.6.2 Project: Glendale Rd/Northampton Landfill Project Owner: American Tower Project Location: 114 Glendale Rd., Florence, MA 01062 Architect/Engineer: William R. Heiden, Ill In accordance with Section 107.6, of the Massachusetts State Building Code,780 CMR 8th Edition I William R. Heiden, III Registration No. 45044 being a registered professional engineer/architect,hereby certify that I have prepared or directly supervised the preparation of all design plans, computation and specifications concerning: Entire Project Architectural ❑✓ Structural ❑ Mechanical Fire Protection J Electrical ❑ Other(Specify) For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the Building Permit and shall be responsible for the following as specified in Section 107.6. 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in Chapter 17. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the construction documents and this code. Pursuant to Section 107.6.2.3, I shall submit periodically a progress report together with pertinent comments to the Building Inspector. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. s�eeNOFMgsSI WIWAM R. ti Enter in the space to the right a"wet"or HEIDEN,111 u� Electronic signature and seal: o No 5It�i4 s tiA_____ / k„ ....44 L., „v.4„,„,<„,e,-, (800) 377-2929 wheiden@mlcomm.com Phone Number Email Building Official Use Only Building Official Name: Permit No.BP- - Note 1.Indicate with an"X"project design plans,computations and specifications that you prepared or directly supervised. If "other"is chosen provide a description. Phase Construction Control Document To be submitted at completion of required site reviews of phase construction for work per the 8th edition of the • ,w Massachusetts State Building Code, 780 CMR, Section 107.6.2.2 �.— rev Project Title: Glendale Rd/Northampton Landfill Date: 8/17/23 Permit No. BP- ........................... Property Address: 114 Glendale Rd., Florence, MA 01062 l William R. Heiden, III MA Registration Number: 45044 Expiration date: 6/30/24 am a registered design professional and I hereby certify that I or my designee have inspected the following work, and I certify that the work has been performed in a manner consistent with the approved plans and specifications for the following phase of construction as indicated: Required Site Review and Documentation for Phase Construction 1,6 (to be performed by the appropriate registered design professional or his/her designee or M.G.L.c 112§81R contractor) Site Review and Documentation R Site Review and Documentation R Soil condition and analysis / Energy efficiency Footing and Foundation,including Reinforcement and Fire Alarm Installation Foundation attachment Concrete Floor and Under Floor Fire Suppression Installation' Lowest Floor Flood Elevation Field Reports' Structural Frame—wall/floor/roof Carbon Monoxide Detection System4 Lath and Plaster/Gypsum Seismic reinforcement Fire Resistant Wall/Partitions framing Smoke Control Systems Fire Resistant Wall/Partitions finish attachments Smoke and Heat Vents Above Ceiling inspection Accessibility(521 CMR) Fire Blockin Sto m S stem Other:Installation of communication antennas,assoc. pp g 4� mounts,&assoc.ground equipment ✓ Ismergcncy Lighting/Exit Signage Means of Egress Componenets Special Inspections(Section 1704): Roofing,coping/System Venting Systems(kitchen,chemical,fume) Mechanical Systems 1.Indicate with an'x'the work you reviewed for compliance with the approved plans and specifications and describe in detail below. 2.Include NFPA 72 test and acceptance documentation 3.Include applicable NFPA 13, 13R, 13D, 14, 15, 17,20,241,etc.-test and acceptance documentation 4.Include NFPA 720 Record of Completion and Inspection and Test Form 5.Include field reports and related documentation 6.Nothing contained within construction control shall have the effect of waiving or limiting the building official's authority to enforce this code with respect to examination of the contract documents,including plans,computations and specifications,and field inspections. Work Descriptiona: Installation of communication antennas, assoc. mounts, &assoc. ground equipment N a.Desrnbe in sufficient detail the work(i.e.foundation steel reinforcing,kitchen vent sl,to `� lc to a .ect site.and list if applicable,the submittal documents that pettam to the work which was inspected. \ sty WILLIAM R. HEIDEN,ILI m CIVIL Enter in the space to the right a"wet"or 0 No 4504 -4 electronic signature and seal: 'S,c d Gt.6 ' S Olt , Phone number: (800) 377-2929 c Email: wheiden©mlcomm.com Building Official Use Only 8/17/23 Building Official Name: Date: Trial Version 10 09 2012